Heart transplantation for chronic chagas' heart disease

Bocchi, Edimar Alcides; Bellotti, Giovanni; Mocelin, Amílcar Oshiro; Uip, David Éverson; Bacal, Fernando; Higuchi, Maria de Lourdes; Amato-Neto, Vicente; Fiorelli, A; Na, Stolf; Jatene, Adib; Pileggi, F

doi:10.1016/0003-4975(96)00141-5

Cited by 106 publications

(77 citation statements)

References 11 publications

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“…Previous studies have demonstrated that prophylaxis has not been effective in preventing reactivation of CD in chagasic recipients who underwent heart transplantation. 8 On the other hand, severe side effects associated to BZ therapy were described in a high percentage of adult immunocompetent CD patients, although signs of bone marrow toxicity -a severe side effect associated to this drug -were not observed in our BMT recipients.…”

Section: Discussionmentioning

confidence: 60%

“…Human transmission in rural areas in endemic countries is mainly through triatomine insect bites, but in urban areas in either endemic or nonendemic countries, T. cruzi infection occurs through blood transfusions or occasionally organ transplants. 3,4 The reactivation of CD revealed as a febrile syndrome sometimes accompanied by skin manifestations, myocarditis and meningoencephalitis, has been associated with immunosuppressive states such as those induced by hematological malignancies, 5 corticosteroid therapy, 6 kidney 7 and heart transplantation 8 and AIDS. 9 In recent preliminary studies, we have described 10,11 the outcome of CD in bone marrow transplantation (BMT) patients.…”

Section: Reactivation; Immunosuppressionmentioning

confidence: 99%

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Chagas disease in bone marrow transplantation: an approach to preemptive therapy

Altclas

Sinagra

Dictar

et al. 2005

Bone Marrow Transplant

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Summary:The efficacy of preemptive therapy was evaluated in bone marrow transplantation (BMT) recipients associated with Chagas disease (CD). The criterion to include patients in the protocol was the serological reactivity for CD in recipients and/or donors before transplant. After BMT, the monitoring was performed using the direct Strout method (SM), which detects clinical levels of Trypanosome cruzi parasitemia, and CD conventional serological tests. Monitoring took place during 60 days in ABMT and throughout the immunosuppressive period in allogeneic BMT. Reactivation of CD was diagnosed by detecting T. cruzi parasites in blood or tissues. In primary T. cruzi infection, an additional diagnostic criterion was the serological conversion. A total of 25 CD-BMT patients were included. Two ABMT and four allogeneic BMT recipients showed CD recurrences diagnosed by SM. One patient also showed skin lesions with T. cruzi amastigotes. Benznidazole treatment (Roche Lab), an antiparasitic drug, was prescribed at a dose of 5 mg/kg/day during 4-8 weeks with recovery of patients. Primary T. cruzi infection was not observed. This report proves the relevance of monitoring CD in BMT patients and demonstrates that preemptive therapy was able to abrogate the development of clinical and systemic disease.

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Section: Discussionmentioning

confidence: 60%

Section: Reactivation; Immunosuppressionmentioning

confidence: 99%

Chagas disease in bone marrow transplantation: an approach to preemptive therapy

Altclas

Sinagra

Dictar

et al. 2005

Bone Marrow Transplant

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“…24 Furthermore, the finding of infection with T. cruzi after transfusion with blood from chronic chagasic donors and the observation that there is reactivation of parasitemia in immunosuppressed patients supports the interpretation that T. cruzi parasites persist in the host. 25,26 However, this study suggests that it is unlikely that the heart tissue of patients with chronic Chagas' heart disease is a major reservoir of the parasites.…”

Section: Discussionmentioning

confidence: 73%

Analysis of the Presence of Trypanosoma Cruzi in the Heart Tissue of Three Patients With Chronic Chagas’ Heart Disease

Elias

Vigliano²,

Laguens³

et al. 2003

The American Journal of Tropical Medicine and Hygiene

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Abstract. It is still unclear to what extent myocarditis-associated, chronic Chagas' heart disease is due to persisting Trypanosoma cruzi. In the present study, we have analyzed tissue samples from the hearts of three patients with this disease. In situ hybridization provided little evidence for the presence of intact T. cruzi, even at sites of strong inflammation. Nevertheless, micromanipulation techniques detected remnants of both T. cruzi kinetoplast DNA and nuclear DNA. Trypanosoma cruzi DNA was also detected in single macrophages dissected directly from frozen heart tissue sections. Thus, this analysis demonstrates that T. cruzi kinetoplast DNA and nuclear DNA are widely dispersed in the heart tissue, although in low amounts. Since we rarely detected intact T. cruzi parasites during the chronic phase of Chagas' heart disease, we can exclude heart tissue as a major parasite reservoir.

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“…f. However, since 2009, the possibility of patients with Chagas disease being accepted as organ donors in Brazil has been restricted by transplant regulations (184) , with systematic serologic screening limiting this type of donation in individuals with T. cruzi infection. However, these same organs can function as "marginal organs" in specific situations (184) (305) (307) .…”

Section: Guidance For the Recipient Without Chagas Diseasementioning

confidence: 99%